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research-article2014
NSQXXX10.1177/0894318414522662Nursing Science QuarterlyClarke and Fawcett / Scholarly Dialogue
Scholarly Dialogue
Transformative Leadership Based on Nursing Science
Nursing Science Quarterly 2014, Vol. 27(2) 126–131 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414522662 nsq.sagepub.com
Pamela N. Clarke, RN; PhD, FAAN,1 William Cody, RN; PhD; FAAN,2 and Richard Cowling, RN; PhD; FAAN3
Abstract The dialogue for this column is a summary of a dialogue among two preeminent nursing scholars and myself that took place “live” at the 40th Meeting of the American Academy of Nursing, focused on transforming healthcare. The dialogue was recorded and transcribed verbatim. In editing the dialogue I tried to leave it conversational which was the nature of the interaction. The paper that follows reflects the thinking of two executive nurse leaders who use different nursing frameworks as the basis for their practice. Translation of their practice models to leadership is presented as a natural transition to transformation. Keywords humanbecoming framework, leadership, nursing, nursing theories transformative leadership, unitary framework The dialogue that follows documents a conversation with two executive leaders about their approach to leadership as driven by nursing models. Dr. William Cody is the director of the school of nursing at DePaul University and Dr. Richard Cowling is Vice President of Academic Affairs at Chamberlain College of Nursing. Both are well-published scholars and long-standing members of the American Academy of Nursing. I was delighted that they accepted my invitation to meet and deliberate about the role of nursing science in the leadership arena. Pamela Clarke (PC): We are meeting together to talk about the synergy between nursing theory and leadership. The overall goal is to talk about how nursing knowledge informs your leadership. Would you begin to describe the connection between leadership and nursing theory? Richard Cowing (RC): The prevailing theoretical perspective that guides my work is the unitary nursing framework (Rogers, 1992). The central idea in unitary nursing science is the notion of wholeness. Working in a very complex and large organization I have to remind myself of the wholeness of the organization. I think of my own work as an evolution of unitary nursing in the form of unitary appreciative inquiry and praxis or appreciative nursing (Cowling & Repede, 2010; Cowling & Swartout, 2011). In the academic setting, one of the things I did early on was to talk about what it would mean to apply those principles of appreciative nursing and nursing practice to education, appreciating students in their wholeness. I brought that idea into the
organization with my philosophy from unitary science to attempt to attract people to the idea rather than promote it as the only way of approaching academics. I believe that I have used the lens of unitary nursing science to inform what I do in my academic leadership role; in some ways a form of unitary appreciative praxis. There are other ways too that theory guides what I do and it is probably around the concept of mutual process. Relationships are extremely important and developing relationships and paying attention to patterns, in terms of what is happening is crucial. While metrics are important indicators of how an academic organization is doing, the quality and nature of the patterning of relationships is another important gauge of contributions. I highly value the notion that student and faculty mutual process is a central force in facilitating positive and enduring change in learning and teaching. Metrics are important too, but I believe that we use them to give us clues to the patterning of the organization rather than using them as the sole indicator which is reductionistic. It is important to remember that there is always something underneath the metrics; they are a clue into the wholeness of what is happening. 1
Professor and Director of Community Health, University of Wyoming Director, School of Nursing, DePaul University 3 Vice President of Academic Affairs, Chamberlain College of Nursing 2
Contributing Editor: Pamela N. Clarke, RN, PhD, FAAN, Professor, University of Wyoming, School of Nursing, Dept. 3065, 1000 E. University Ave., Laramie, Wyoming 82079. Email: [email protected]
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Clarke and Fawcett / Scholarly Dialogue PC: In unitary science normally one wouldn’t view metrics as that important, yet you value the metrics as one indicator out of many? RC: Yes, in some of my own writing I talked about the conceptualization of practice where you don’t dismiss, because you are unitary, the information that comes to you that is physiological, spiritual, or emotional. You don’t dismiss it, what you do is understand it in the context of the whole, not as reducing the whole to that experience or particular phenomenon, but all those phenomena are clues, in a sense, to the overarching pattern (Cowling, 1993). If you carry that idea to an academic organization, where you’re a leader, you understand the importance of factors like persistence, retention, graduation rates, student performance, and NCLEX (National Council Licensure Examination) pass rates as indicators of academic patterning and mutual process infused in the organization. There is more to the story that helps you appreciate the relevance of that to the wholeness. For instance, in our organization we started a movement called Chamberlain Care. It’s not caring in the way we think about caring in nursing science, it’s more the noun, like we all deserve the best care. In Chamberlain Care, I believe we are looking at academic success for the standpoint of wholeness. We give attention to our own well-being, the well-being of our colleagues, and the well-being of the students with a focus on them realizing their dreams and desires. We are designing Chamberlain Care to be a force for creating an environment that supports all of this. We believe that doing this means that we are developing our students’ potentials to be extraordinary and transform healthcare worldwide, even if it is one person, family, or community at time. Our employees are colleagues and thus we think of them differently with the idea of mutual process than we would if we thought of them as our employees. We are essentially evoking a new form of mutual process by re-thinking our relationships. William Cody (WC): I appreciate what you’re saying about a framework within your organization that resonates with your nursing theoretical framework. I’ve experienced something similar at DePaul, in that DePaul is a Vincentian organization and the framework of values is concerned preeminently with service to humankind and upholding human dignity. This perspective resonates well with nursing, but also my theoretical grounding in the humanbecoming school of thought. Human dignity is central to both frameworks (Parse, 2010). As leaders we know that we need to be in an organization in which we can embrace the mission, and help to build the mission and vision. This commitment is central to the leadership challenge that we all face. One’s theoretical framework informs this process of aligning mission, vision, values, and
strategic planning. Part of living my beliefs in my role as the director of the school of nursing, emanates from the humanbecoming school of thought, is the reverence for the people that I work with and work for. This reverence moves me to be fully and truly present, and really listen to what they are saying, and to try to use my personal presence to pull together our common vision. I feel like the relational aspect of nursing that comes to me from my particular theoretical framework really helps me to be able to be with my team in that way. PC: You have talked about the Parse concept, leadingfollowing. Would you describe the fit with leadingfollowing in your leadership model? WC: Parse (2008) has written about the concept, and the central essences are vision, risking, and reverence for others. I was pondering these concepts, and they speak to me in terms of the vision. Having been through leadership training and having been in a middle executive position for a good many years, we always talk about the mission and vision. There’s the sense of it that is more directed toward achieving some end, but if one comes from a place where one’s assumption is that we’re co-creating something together and that there’s a seamlessness to it, then my job is to facilitate co-creating a vision we can all share in and that we can all embrace, and that comes from the values that underpin our organization. When we grow the vision, if we want to bring to realization and participate in transforming a new vision of the way nursing might be, or the way that our organization might be, or the way people might be served in healthcare, then there is going to be a certain risk. The leader’s job is to get everyone to embrace the risk and take the challenge and move forward, and it can be very difficult to get people to embrace that risk. Parse’s (2008) view is that if you’re leading you’re also following. RC: They are not extracted from one another. That makes sense. I like the leading and following concept; I translate it in a unitary way to attraction and appreciation. For instance, the more I appreciate my colleagues the more attraction there is to bettering our relationships; there is less push and pull and more cooperativeness and collaboration. WC: The concepts are not oppositional. They are intrinsically in a rhythmical pattern. I certainly follow in terms of being a so-called leader. In trying to facilitate others doing something, they are doing it, so in some sense I am following them. PC: You both make your theory-driven leadership styles sound so easy. Are there difficult areas? RC: One of the most difficult concepts for me to integrate into an academic organization as a leader is the unitary
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Nursing Science Quarterly 27(2)
idea of unpredictability. In the organization I work for it seems to be we’re trying to get a handle on predicting what is going to happen in the future in order to manage it, or take advantage of it, or leverage it. It is not meant in a negative way, but to grow the organization, to grow what we’re about, to promote our mission, our vision, our philosophy. What I carry into those situations, is trying to envision the future and doing the best we can to envision what is going to happen and to be there to build on what we believe, which is to prepare extraordinary nurses to transform healthcare worldwide, that’s our vision. I prefer an understanding of the unpredictability of the future as meaning many possibilities can unfold that we cannot imagine. It is allowing the organization to dream big and that allows us to consider all kinds of approaches to educating our students and paying attention to how this works for them and for us. As a member of a leadership team, I work to build on building relationships and how we might contribute to a shared vision that leads to something greater than anyone of us can imagine individually. I carry my theoretical framework into our leadership discussions. Often I’m not using the words of theory, but using the ideas of the theory, or the conceptualizations to talk about issues, the problem, the challenge we face, or the opportunity we’re trying to build for ourselves. Unitary science is an optimistic framework with infinite possibilities. In terms of humanbecoming, it carries not only a way of thinking, but an attitude, a feeling state, and all of those things that are aspects of the whole, into it, that changes the way you do your work, the way other people see you. It’s kind of a mutual process that is more beneficial in many ways than is typically seen in the problem-oriented approach. WC: Certainly one of the aspects of being a leader in nursing in a new paradigm framework is dealing with the need for measurement, the need for predictability, and in our discipline, the evidence-based practice movement. The reality is that there are a lot of instances that we encounter when we are caring for human beings where there is no objective, cause-effect evidence out there. In human care, the amount or percentage of the care that can be predicted through randomized clinical trial research is very minimal. Thus, one thing that I’ve taken into my last three jobs, coming from a different paradigm, has been to keep hammering on how much of our care is actually values-based. We value human dignity. I don’t practice my profession this way because of the evidence from the research, but because I value human dignity and I value relating to human beings and being truly present with human beings, while honoring their human dignity. This perspective has actually resulted in changes in the curriculum framework the last two jobs, and I’m working on a revision right now in which we will be sure to get the
values-base in there. Unfortunately, there are places in our profession where it can be eclipsed to just get on the evidence-based “band wagon.” PC: What was the process you used to accomplish the change in thinking, at the last two places? WC: By engaging with the faculty toward realizing a common vision that our curriculum would not be solely objectivistic science, but would include values like human dignity. One curriculum, for example, portrayed values and evidence as twin pillars of the curriculum. RC: Along those lines when you are trying to promote change like that, where you have theoretical concepts that you want to integrate into your work, I believe that it is actually about creating a mutual process that allows for diversity of thinking, but finds common ground. The process seems to be about synergy; things changing positively, and perhaps accelerated, when you connect to a bigger goal. As a leader, I focus on the goal and share different ways of realizing that goal that evokes more creative approaches to teaching. The faculty teaching from a biomedical perspective teach from that perspective because they truly believe it; I have to remember that for them, just as it is for me when I am teaching from my perspective, it resonates with their heart, their soul, and their cognition; everything. They are doing it as passionately as I would probably be teaching something from my frame of reference, and if you create a mutual process where you say the possibility of having people recover in a healthy way from cardiac challenges by using an understanding of the wholeness of their experience and relate it to what they are trying to accomplish, you can find this common ground where there is at least a potential to consider the possibility that there is another way of viewing the person rather than an illness-centered view. Most of the time I find that the people who are very “bio-medical” want the human condition to improve and they see it happening in a very different way. I am very empathetic about faculty because of what they face in terms of trying to prepare graduates for a healthcare system that is metrically driven, and evidence-based. They are trying to prepare students to live in that world and most understand that human experience and the nature of life are more than the biomedical phenomena. PC: In terms of faculty, how are your faculty informed about your theoretical approach? RC: Their knowledge of my theoretical framework may come from either knowing about my writings or my role as the editor of the Journal of Holistic Nursing. Often they will reach out to me and ask me about it which leads to some interesting conversations. Many of them have the same appreciation for a unitary perspective. I was also invited to give the opening address
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Clarke and Fawcett / Scholarly Dialogue at our national faculty meeting and I spoke on appreciative nursing education. I also look for examples of innovative theoretically-driven pilots or demonstration projects going on and encourage and support faculty. Often these projects attract other faculty because they see the positive changes happening in students. That’s an attractive force, and you look for those little opportunities for change. PC: Chamberlain is a large multi-state organization. How will the small changes you are talking influence the whole? RC: In our organization, all of the faculty members who are teaching the same course are part of what we call collaboratives. These instructors are talking about what works and what doesn’t and sharing best practices. Sometimes best practices are really the most innovative things that have yet to be tested. This is how faculty members across such a large organization are able to connect. We use technology so the collaborative is happening virtually and through other outlets. I like the concept of being values-driven, and I trust that is true of my organization. We share a common framework of values that we operate from, but it might express itself in different ways depending on what you do and where you are located. If you are in Phoenix you might be dealing with a population that has different needs than in Florida. You have to allow for the differences but embrace those universal values in whatever kind of educational experience you are creating for students. The frameworks that Bill and I come from allow for that kind of diversity. WC: In talking with coworkers and colleagues, when we are having dialogue and envisioning projects, I find that I talk to them in ways that are similar to the way I talk to persons practicing as humanbecoming nurses. It’s an extraordinary witnessing, and I use phrases similar to what I would ask in practice, “Well, what does that mean to you?” and “What’s most important about that to you?” and “What would be the pros and cons of that?” If a direction emerges, then “Who could help? What kinds of things would help to move that along?” Ultimately “What do you picture this being in the end?” Going through a similar process as I would with the person I am having the dialogue with in practice as to “What does it mean to you?” I regard it as an ethical commitment to bear witness to the truths of the faculty whom I serve as leader. I seek to understand their living experiences, their values, their commitments; then we go from there (Cody, 2001). PC: As you talk, I’m picturing this discussion with a much larger group using your practice methodology. WC: Using a form of it. As the director, the supervisor, I’m hesitant to call it true presence, because I’m not giving myself over entirely to it as I would with a person, because I was hired by the organization, I do have
an agenda. The centerpiece of my agenda is to help people to develop and so it’s really about them. That meshes very nicely with my practice perspective. RC: I was thinking as Bill was talking, in Rogerian unitary science we don’t use the terms of being and becoming. However, I do think that unitary science offers a parallel view of understanding oneself as always unfolding and gaining greater and greater awareness through knowing participation in change (Barrett, 1998). Also, cognition, inspiration, and sensations are intertwined phenomena that cannot be understood when divided as mind, body, and spirit. One of these phenomena has no precedence over the others. In an academic environment, for me I have to pay attention to all of them in order to be best at leading our educational work. I pay attention to experiences or cases when I am being inconsistent; for instance, reducing academic success to NCLEX scores. I have to remind myself that there is more there. I want our students to be stellar in their NCLEX scores, but more than that I want them to be stellar in terms of their practice as nurses. When you embrace a frame of reference in a theoretical framework, it makes you more aware of what you’re doing and how it relates to what you believe. It makes you more conscious of what you’re doing. To me it doesn’t matter whether you’re a leader, a teacher, or a practitioner, your consciousness changes when you get deeply engaged with a framework, whether it is one of the frameworks Bill and I are talking about, or another. One is different in the world. WC: The process of reflecting in preparation for this dialogue brought me to realize I hadn’t actually fully integrated my own philosophical assumptions about what informs my leadership. One would think after going through leadership training programs that I might have done that. I was thinking about some ways that being in a new paradigm informed a process that might be different or advantageous in ways that I had never really thought about. I considered the assumption that change and transformation are continuous, these are always happening and it’s indivisible. That’s an important part of who I am and how I experience the world, as a nurse, as a leader. It seems as though the challenge is to work to co-create a chosen pattern or set of values, to make reality come to be in a chosen way, or to “participate knowingly” (Barrett, 1998, p. 138) in change from Rogerian science. That’s a fundamental assumption of who I am and what I’m about. I just had not really questioned it or thought about what it might mean that it might be different from other people in leadership positions. RC: The concept of participating knowingly in change, as articulated by Barrett (1998), is a key idea. I would add the notion of appreciation, so I believe that participating knowingly and appreciatively in change broadens possibilities for organizational and academic innovation. To participate knowingly in change means seizing
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Nursing Science Quarterly 27(2) the opportunity to promote change based on awareness of the patterning and wholeness of your organization. Barrett suggested that power, choice, and freedom emerge or evolve with knowing participation in change. To participate appreciatively adds to this a willingness to suspend judgment and value and embrace all aspects of an organization when considering change – even those aspects that seem antithetical to what is desired. The more you appreciate multiple ways of viewing things the more you experience consciousness-raising associated with seeing more possibilities that inform your decisions. The organization I’m in now is also a business and they are always reflecting on who they are and what they’re about, which is like getting in touch with appreciating what they’re about and want to be. For me, what I’m finding is that many organizations are welcoming the way of thinking that I bring, because they are also asking themselves, what’s happening in our organization, what works, where are we struggling, and what are the patterns that can guide us to consider new ways of meeting our goals? Organizations are learning about themselves, they are becoming more conscious, at least that’s my optimistic view; they are working toward, embracing, different paradigms. There are still a lot of old ways of thinking, but the way we think about leadership now is more in the vein of wholeness and patterning and mutual process.
PC: Certainly we see new paradigm thinking in the literature in terms of the evolution from management to leadership. RC: I wonder too, if there is something that goes beyond leadership? WC: Mainstream organizations are shifting more and more toward new paradigm thinking. By the time they get there they won’t be new paradigms anymore. Maybe that’s true already, but, for example, appreciative inquiry is in the mainstream textbooks. And values-based has become a buzz-word in schools of business. The business school leaders go beyond business itself to valuesbased concepts and vision, which means you have a vision rooted in values; you want to co-create, and that’s actually mainstream now. Richard is right, the new thinking is more valued now than it has been in the past and it’s welcomed even beyond nursing. RC: We started a service excellence project at Chamberlain. We wanted to get out of the mindset of reducing it to the customer. My president was asked to take the lead on this project for our parent organization and she engaged her colleagues in creating a model within our College. The concept that she worked from was the idea of that customer service in academia is really about providing the best conditions possible for student success. It does not mean that students do not have accountability for their own learning, but rather
excellent service means assuring that we do everything that is possible to facilitate students reaching their optimal possibilities. That was the birthing of what we call Chamberlain Care. A part of this initiative is for all of us, no matter what we do in the organization, to remember that the student is the center of the concern of our organization. A mortarboard that is placed in every meeting room of our home office symbolizes their success. This serves to remind us why we exist. I think of it is as an expression of the unitary concept of pan-dimensionality – we bring the student into our meetings without their physical presence. By doing this a kind of energy is created through symbolism and metaphor that says, “We’re here doing this work for our students.” PC: Coming into the Robert Wood Johnson (RWJ) Executive Nurse Leaders experience as a Parse scholar Bill, how would you describe the impact of the leadership experience on your perspective? WC: The thing that jumped out at me was the notion, we were talking about earlier about the Robert Wood Johnson Executive Nurse Leaders experience; Two things I took away from that was leading as who you are and knowing self in order to be a strong leader. For me, that is very much analogous to knowing oneself within the context of one’s theoretical perspective, and I’ve written about that (Cody, 2000). If my theoretical perspective informs my understanding of my own reality then leading as who I am is also leading from that theoretical perspective. The RWJ experience also gave me the chance to appreciate the huge diversity of leadership styles. We have introverts and extroverts (in traditional terms), and when we would practice presentations in our groups some people would turn cartwheels and others would want to stand at the podium and some would sing. Others would be very good at creating diagrams or models. Some would be forcefully persuasive with public speaking and others would be subtly persuasive in soft tones. New paradigm theories lead us to appreciate human individuality and the uniqueness of each human being. When you express yourself as a leader in the way that is best for you, as a person, to express yourself, then that helps to develop all the members of your work group or team or colleagues to be who they are and to fully realize who they are. That, to me, is the essence of leadership. RC: That’s a central core idea, you mention Bill, which I too seek in my experience as a vice president because we employ executive coaches. One of the executive coaches that we use with individuals and our team always starts with the principle: you have to be who you are. This is not about changing centrally who you are, as a matter of fact it’s embracing who you are and paying attention to how authentic and genuine you are in the organization and when you
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Clarke and Fawcett / Scholarly Dialogue feel you can’t be that’s informational energy telling you that something is going on. We are such a thought-driven culture but paying attention to how we feel is also important. That kind of coaching is in line with what you are saying. My executive coach would always start with me reflecting on who I am and what I want; thinking of the match between the job I chose and me as a person. The approach is truly central and goes along with the newer transformational paradigms of leadership. PC: Richard, talk about the principle of the Chamberlain model and the impact on employees and colleagues. RC: The whole of the DeVry Company decided to have yearly summits where they bring in organizational leaders. We had one last year and brought in a guy who teaches leadership from the paradigm of the symphony. As a former conductor, he brought an orchestra into a room of 400 participants and asked everyone to move about, paying attention to the changes in music; particularly when he told a section to do something different or more creative. Then he asked, “What happened here?” He applied it to organizational theories of leadership. The metaphor of the symphony and the relationships among all in creating conditions of change is another expression of the relevance of patterning, wholeness, and mutual process in an organization. All of this is about learning a new consciousness that leads to new unitary competencies. PC: Perhaps we could summarize by talking a bit about the structure of your organizations, As I understand it yours Richard is a private proprietary, and yours Bill, yours is a religious institution. WC: Yes, it’s Roman Catholic and Vincentian. I was actually thinking about that in relation to pan-dimensionality from unitary science, and Parse’s concept of illimitability from humanbecoming theory. The two people who are with us always at a Vincentian institution are St. Vincent DePaul and St. Louise DeMarillac, who was his partner, in the chaste sense. She was a religious woman, and co-founder with Vincent of the Daughters of Charity. They are really with us every day, the whole notion of what they founded, and their statues are on campus. It’s interesting, the difference between St. Ignatius Loyola, at Loyola there’s a statue and he’s sort of imperious and seated alone, and then on the campus of DePaul the statue of St. Vincent is actually hanging out with other bronze statues of kids with their backpacks. I was thinking of that when you are talking about pan-dimensionality. They are definitely with us. They inspire servant leadership, and I have found servant leadership to be consistent with my values base in humanbecoming, in terms of being a servant to the mission and vision of the organization, to my colleagues and co-workers; and the service I provide is to try and lead them. The measure of success, according to the founder of the servant leadership movement, Robert
Greenleaf (Greenleaf, Frick, & Spears, 1996), is the extent of the development of your followers, how well do they develop as human beings and as servants. RC: There is an interesting parallel, I may have a misunderstanding of this, but DeVry Educational Group purchased Deaconess Hospital School of Nursing in St. Louis, which was how Chamberlain originated. Part of the contract was that they use a different name, so they started with a few hundred students. Deaconess has a history; they would be 125 years old today. We see ourselves rooted in Deaconess, which was also a Deaconess Order, and they built a school on the Nightingale model. When we purchased Deaconess, we embraced all of that in a sense; we have some of their statuary that we transported from the old school. There was a lot of discussion about the new name, and Chamberlain has a connotation of “chief steward.” It conveys that we are the stewards of the student’s wellbeing and success. We have grown a lot, we have 13 campuses that are brick and mortar for our pre-licensure BSN program, an RN to BSN program and a variety of master’s tracks (leadership, informatics, and education) and a doctor of nursing practice (clinical and health systems leadership) program that are primarily online. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this column.
Funding The authors received no financial support for the authorship and/or publication of this column.
References Barrett, E. A. M. (1998). A Rogerian practice methodology for health patterning. Nursing Science Quarterly, 11(4), 136-138. Cody, W. K. (2000). Theoretical concerns. Nursing science frameworks for practice and research as means of knowing self. Nursing Science Quarterly, 13, 188-195. Cody, W. K. (2001). Ethical issues. The ethics of bearing witness in healthcare; A beginning exploration. Nursing Science Quarterly, 14, 288-296. Cowling, W. R., & Swartout, K. M. (2011). Wholeness and life patterning: Unitary foundations for a healing praxis. Advances in Nursing Science, 34(7), 51-66. Cowling, W. R., III., & Repede, E. (2010). Unitary appreciative inquiry: Evolution and refinement. Advances in Nursing Science, 33(1), 64-77. Cowling, W. R., III. (1993). Unitary knowing in nursing practice. Nursing Science Quarterly, 6(4), 201-207. Greenleaf, R. K., Frick, D. M., & Spears, L. C. (Eds.) (1996). On becoming a servant-leader. San Francisco: Jossey Bass. Parse, R. R. (2008). The humanbecoming leading-following model. Nursing Science Quarterly, 21, 369-375. Parse, R. T. (2010). Human dignity: A humanbecoming ethical phenomenon. Nursing Science Quarterly, 23, 257-262. Rogers, M. E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5(1), 27-33.
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research-article2014
NSQXXX10.1177/0894318414522662Nursing Science QuarterlyClarke and Fawcett / Scholarly Dialogue
Scholarly Dialogue
Transformative Leadership Based on Nursing Science
Nursing Science Quarterly 2014, Vol. 27(2) 126–131 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414522662 nsq.sagepub.com
Pamela N. Clarke, RN; PhD, FAAN,1 William Cody, RN; PhD; FAAN,2 and Richard Cowling, RN; PhD; FAAN3
Abstract The dialogue for this column is a summary of a dialogue among two preeminent nursing scholars and myself that took place “live” at the 40th Meeting of the American Academy of Nursing, focused on transforming healthcare. The dialogue was recorded and transcribed verbatim. In editing the dialogue I tried to leave it conversational which was the nature of the interaction. The paper that follows reflects the thinking of two executive nurse leaders who use different nursing frameworks as the basis for their practice. Translation of their practice models to leadership is presented as a natural transition to transformation. Keywords humanbecoming framework, leadership, nursing, nursing theories transformative leadership, unitary framework The dialogue that follows documents a conversation with two executive leaders about their approach to leadership as driven by nursing models. Dr. William Cody is the director of the school of nursing at DePaul University and Dr. Richard Cowling is Vice President of Academic Affairs at Chamberlain College of Nursing. Both are well-published scholars and long-standing members of the American Academy of Nursing. I was delighted that they accepted my invitation to meet and deliberate about the role of nursing science in the leadership arena. Pamela Clarke (PC): We are meeting together to talk about the synergy between nursing theory and leadership. The overall goal is to talk about how nursing knowledge informs your leadership. Would you begin to describe the connection between leadership and nursing theory? Richard Cowing (RC): The prevailing theoretical perspective that guides my work is the unitary nursing framework (Rogers, 1992). The central idea in unitary nursing science is the notion of wholeness. Working in a very complex and large organization I have to remind myself of the wholeness of the organization. I think of my own work as an evolution of unitary nursing in the form of unitary appreciative inquiry and praxis or appreciative nursing (Cowling & Repede, 2010; Cowling & Swartout, 2011). In the academic setting, one of the things I did early on was to talk about what it would mean to apply those principles of appreciative nursing and nursing practice to education, appreciating students in their wholeness. I brought that idea into the
organization with my philosophy from unitary science to attempt to attract people to the idea rather than promote it as the only way of approaching academics. I believe that I have used the lens of unitary nursing science to inform what I do in my academic leadership role; in some ways a form of unitary appreciative praxis. There are other ways too that theory guides what I do and it is probably around the concept of mutual process. Relationships are extremely important and developing relationships and paying attention to patterns, in terms of what is happening is crucial. While metrics are important indicators of how an academic organization is doing, the quality and nature of the patterning of relationships is another important gauge of contributions. I highly value the notion that student and faculty mutual process is a central force in facilitating positive and enduring change in learning and teaching. Metrics are important too, but I believe that we use them to give us clues to the patterning of the organization rather than using them as the sole indicator which is reductionistic. It is important to remember that there is always something underneath the metrics; they are a clue into the wholeness of what is happening. 1
Professor and Director of Community Health, University of Wyoming Director, School of Nursing, DePaul University 3 Vice President of Academic Affairs, Chamberlain College of Nursing 2
Contributing Editor: Pamela N. Clarke, RN, PhD, FAAN, Professor, University of Wyoming, School of Nursing, Dept. 3065, 1000 E. University Ave., Laramie, Wyoming 82079. Email: [email protected]
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Clarke and Fawcett / Scholarly Dialogue PC: In unitary science normally one wouldn’t view metrics as that important, yet you value the metrics as one indicator out of many? RC: Yes, in some of my own writing I talked about the conceptualization of practice where you don’t dismiss, because you are unitary, the information that comes to you that is physiological, spiritual, or emotional. You don’t dismiss it, what you do is understand it in the context of the whole, not as reducing the whole to that experience or particular phenomenon, but all those phenomena are clues, in a sense, to the overarching pattern (Cowling, 1993). If you carry that idea to an academic organization, where you’re a leader, you understand the importance of factors like persistence, retention, graduation rates, student performance, and NCLEX (National Council Licensure Examination) pass rates as indicators of academic patterning and mutual process infused in the organization. There is more to the story that helps you appreciate the relevance of that to the wholeness. For instance, in our organization we started a movement called Chamberlain Care. It’s not caring in the way we think about caring in nursing science, it’s more the noun, like we all deserve the best care. In Chamberlain Care, I believe we are looking at academic success for the standpoint of wholeness. We give attention to our own well-being, the well-being of our colleagues, and the well-being of the students with a focus on them realizing their dreams and desires. We are designing Chamberlain Care to be a force for creating an environment that supports all of this. We believe that doing this means that we are developing our students’ potentials to be extraordinary and transform healthcare worldwide, even if it is one person, family, or community at time. Our employees are colleagues and thus we think of them differently with the idea of mutual process than we would if we thought of them as our employees. We are essentially evoking a new form of mutual process by re-thinking our relationships. William Cody (WC): I appreciate what you’re saying about a framework within your organization that resonates with your nursing theoretical framework. I’ve experienced something similar at DePaul, in that DePaul is a Vincentian organization and the framework of values is concerned preeminently with service to humankind and upholding human dignity. This perspective resonates well with nursing, but also my theoretical grounding in the humanbecoming school of thought. Human dignity is central to both frameworks (Parse, 2010). As leaders we know that we need to be in an organization in which we can embrace the mission, and help to build the mission and vision. This commitment is central to the leadership challenge that we all face. One’s theoretical framework informs this process of aligning mission, vision, values, and
strategic planning. Part of living my beliefs in my role as the director of the school of nursing, emanates from the humanbecoming school of thought, is the reverence for the people that I work with and work for. This reverence moves me to be fully and truly present, and really listen to what they are saying, and to try to use my personal presence to pull together our common vision. I feel like the relational aspect of nursing that comes to me from my particular theoretical framework really helps me to be able to be with my team in that way. PC: You have talked about the Parse concept, leadingfollowing. Would you describe the fit with leadingfollowing in your leadership model? WC: Parse (2008) has written about the concept, and the central essences are vision, risking, and reverence for others. I was pondering these concepts, and they speak to me in terms of the vision. Having been through leadership training and having been in a middle executive position for a good many years, we always talk about the mission and vision. There’s the sense of it that is more directed toward achieving some end, but if one comes from a place where one’s assumption is that we’re co-creating something together and that there’s a seamlessness to it, then my job is to facilitate co-creating a vision we can all share in and that we can all embrace, and that comes from the values that underpin our organization. When we grow the vision, if we want to bring to realization and participate in transforming a new vision of the way nursing might be, or the way that our organization might be, or the way people might be served in healthcare, then there is going to be a certain risk. The leader’s job is to get everyone to embrace the risk and take the challenge and move forward, and it can be very difficult to get people to embrace that risk. Parse’s (2008) view is that if you’re leading you’re also following. RC: They are not extracted from one another. That makes sense. I like the leading and following concept; I translate it in a unitary way to attraction and appreciation. For instance, the more I appreciate my colleagues the more attraction there is to bettering our relationships; there is less push and pull and more cooperativeness and collaboration. WC: The concepts are not oppositional. They are intrinsically in a rhythmical pattern. I certainly follow in terms of being a so-called leader. In trying to facilitate others doing something, they are doing it, so in some sense I am following them. PC: You both make your theory-driven leadership styles sound so easy. Are there difficult areas? RC: One of the most difficult concepts for me to integrate into an academic organization as a leader is the unitary
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Nursing Science Quarterly 27(2)
idea of unpredictability. In the organization I work for it seems to be we’re trying to get a handle on predicting what is going to happen in the future in order to manage it, or take advantage of it, or leverage it. It is not meant in a negative way, but to grow the organization, to grow what we’re about, to promote our mission, our vision, our philosophy. What I carry into those situations, is trying to envision the future and doing the best we can to envision what is going to happen and to be there to build on what we believe, which is to prepare extraordinary nurses to transform healthcare worldwide, that’s our vision. I prefer an understanding of the unpredictability of the future as meaning many possibilities can unfold that we cannot imagine. It is allowing the organization to dream big and that allows us to consider all kinds of approaches to educating our students and paying attention to how this works for them and for us. As a member of a leadership team, I work to build on building relationships and how we might contribute to a shared vision that leads to something greater than anyone of us can imagine individually. I carry my theoretical framework into our leadership discussions. Often I’m not using the words of theory, but using the ideas of the theory, or the conceptualizations to talk about issues, the problem, the challenge we face, or the opportunity we’re trying to build for ourselves. Unitary science is an optimistic framework with infinite possibilities. In terms of humanbecoming, it carries not only a way of thinking, but an attitude, a feeling state, and all of those things that are aspects of the whole, into it, that changes the way you do your work, the way other people see you. It’s kind of a mutual process that is more beneficial in many ways than is typically seen in the problem-oriented approach. WC: Certainly one of the aspects of being a leader in nursing in a new paradigm framework is dealing with the need for measurement, the need for predictability, and in our discipline, the evidence-based practice movement. The reality is that there are a lot of instances that we encounter when we are caring for human beings where there is no objective, cause-effect evidence out there. In human care, the amount or percentage of the care that can be predicted through randomized clinical trial research is very minimal. Thus, one thing that I’ve taken into my last three jobs, coming from a different paradigm, has been to keep hammering on how much of our care is actually values-based. We value human dignity. I don’t practice my profession this way because of the evidence from the research, but because I value human dignity and I value relating to human beings and being truly present with human beings, while honoring their human dignity. This perspective has actually resulted in changes in the curriculum framework the last two jobs, and I’m working on a revision right now in which we will be sure to get the
values-base in there. Unfortunately, there are places in our profession where it can be eclipsed to just get on the evidence-based “band wagon.” PC: What was the process you used to accomplish the change in thinking, at the last two places? WC: By engaging with the faculty toward realizing a common vision that our curriculum would not be solely objectivistic science, but would include values like human dignity. One curriculum, for example, portrayed values and evidence as twin pillars of the curriculum. RC: Along those lines when you are trying to promote change like that, where you have theoretical concepts that you want to integrate into your work, I believe that it is actually about creating a mutual process that allows for diversity of thinking, but finds common ground. The process seems to be about synergy; things changing positively, and perhaps accelerated, when you connect to a bigger goal. As a leader, I focus on the goal and share different ways of realizing that goal that evokes more creative approaches to teaching. The faculty teaching from a biomedical perspective teach from that perspective because they truly believe it; I have to remember that for them, just as it is for me when I am teaching from my perspective, it resonates with their heart, their soul, and their cognition; everything. They are doing it as passionately as I would probably be teaching something from my frame of reference, and if you create a mutual process where you say the possibility of having people recover in a healthy way from cardiac challenges by using an understanding of the wholeness of their experience and relate it to what they are trying to accomplish, you can find this common ground where there is at least a potential to consider the possibility that there is another way of viewing the person rather than an illness-centered view. Most of the time I find that the people who are very “bio-medical” want the human condition to improve and they see it happening in a very different way. I am very empathetic about faculty because of what they face in terms of trying to prepare graduates for a healthcare system that is metrically driven, and evidence-based. They are trying to prepare students to live in that world and most understand that human experience and the nature of life are more than the biomedical phenomena. PC: In terms of faculty, how are your faculty informed about your theoretical approach? RC: Their knowledge of my theoretical framework may come from either knowing about my writings or my role as the editor of the Journal of Holistic Nursing. Often they will reach out to me and ask me about it which leads to some interesting conversations. Many of them have the same appreciation for a unitary perspective. I was also invited to give the opening address
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Clarke and Fawcett / Scholarly Dialogue at our national faculty meeting and I spoke on appreciative nursing education. I also look for examples of innovative theoretically-driven pilots or demonstration projects going on and encourage and support faculty. Often these projects attract other faculty because they see the positive changes happening in students. That’s an attractive force, and you look for those little opportunities for change. PC: Chamberlain is a large multi-state organization. How will the small changes you are talking influence the whole? RC: In our organization, all of the faculty members who are teaching the same course are part of what we call collaboratives. These instructors are talking about what works and what doesn’t and sharing best practices. Sometimes best practices are really the most innovative things that have yet to be tested. This is how faculty members across such a large organization are able to connect. We use technology so the collaborative is happening virtually and through other outlets. I like the concept of being values-driven, and I trust that is true of my organization. We share a common framework of values that we operate from, but it might express itself in different ways depending on what you do and where you are located. If you are in Phoenix you might be dealing with a population that has different needs than in Florida. You have to allow for the differences but embrace those universal values in whatever kind of educational experience you are creating for students. The frameworks that Bill and I come from allow for that kind of diversity. WC: In talking with coworkers and colleagues, when we are having dialogue and envisioning projects, I find that I talk to them in ways that are similar to the way I talk to persons practicing as humanbecoming nurses. It’s an extraordinary witnessing, and I use phrases similar to what I would ask in practice, “Well, what does that mean to you?” and “What’s most important about that to you?” and “What would be the pros and cons of that?” If a direction emerges, then “Who could help? What kinds of things would help to move that along?” Ultimately “What do you picture this being in the end?” Going through a similar process as I would with the person I am having the dialogue with in practice as to “What does it mean to you?” I regard it as an ethical commitment to bear witness to the truths of the faculty whom I serve as leader. I seek to understand their living experiences, their values, their commitments; then we go from there (Cody, 2001). PC: As you talk, I’m picturing this discussion with a much larger group using your practice methodology. WC: Using a form of it. As the director, the supervisor, I’m hesitant to call it true presence, because I’m not giving myself over entirely to it as I would with a person, because I was hired by the organization, I do have
an agenda. The centerpiece of my agenda is to help people to develop and so it’s really about them. That meshes very nicely with my practice perspective. RC: I was thinking as Bill was talking, in Rogerian unitary science we don’t use the terms of being and becoming. However, I do think that unitary science offers a parallel view of understanding oneself as always unfolding and gaining greater and greater awareness through knowing participation in change (Barrett, 1998). Also, cognition, inspiration, and sensations are intertwined phenomena that cannot be understood when divided as mind, body, and spirit. One of these phenomena has no precedence over the others. In an academic environment, for me I have to pay attention to all of them in order to be best at leading our educational work. I pay attention to experiences or cases when I am being inconsistent; for instance, reducing academic success to NCLEX scores. I have to remind myself that there is more there. I want our students to be stellar in their NCLEX scores, but more than that I want them to be stellar in terms of their practice as nurses. When you embrace a frame of reference in a theoretical framework, it makes you more aware of what you’re doing and how it relates to what you believe. It makes you more conscious of what you’re doing. To me it doesn’t matter whether you’re a leader, a teacher, or a practitioner, your consciousness changes when you get deeply engaged with a framework, whether it is one of the frameworks Bill and I are talking about, or another. One is different in the world. WC: The process of reflecting in preparation for this dialogue brought me to realize I hadn’t actually fully integrated my own philosophical assumptions about what informs my leadership. One would think after going through leadership training programs that I might have done that. I was thinking about some ways that being in a new paradigm informed a process that might be different or advantageous in ways that I had never really thought about. I considered the assumption that change and transformation are continuous, these are always happening and it’s indivisible. That’s an important part of who I am and how I experience the world, as a nurse, as a leader. It seems as though the challenge is to work to co-create a chosen pattern or set of values, to make reality come to be in a chosen way, or to “participate knowingly” (Barrett, 1998, p. 138) in change from Rogerian science. That’s a fundamental assumption of who I am and what I’m about. I just had not really questioned it or thought about what it might mean that it might be different from other people in leadership positions. RC: The concept of participating knowingly in change, as articulated by Barrett (1998), is a key idea. I would add the notion of appreciation, so I believe that participating knowingly and appreciatively in change broadens possibilities for organizational and academic innovation. To participate knowingly in change means seizing
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Nursing Science Quarterly 27(2) the opportunity to promote change based on awareness of the patterning and wholeness of your organization. Barrett suggested that power, choice, and freedom emerge or evolve with knowing participation in change. To participate appreciatively adds to this a willingness to suspend judgment and value and embrace all aspects of an organization when considering change – even those aspects that seem antithetical to what is desired. The more you appreciate multiple ways of viewing things the more you experience consciousness-raising associated with seeing more possibilities that inform your decisions. The organization I’m in now is also a business and they are always reflecting on who they are and what they’re about, which is like getting in touch with appreciating what they’re about and want to be. For me, what I’m finding is that many organizations are welcoming the way of thinking that I bring, because they are also asking themselves, what’s happening in our organization, what works, where are we struggling, and what are the patterns that can guide us to consider new ways of meeting our goals? Organizations are learning about themselves, they are becoming more conscious, at least that’s my optimistic view; they are working toward, embracing, different paradigms. There are still a lot of old ways of thinking, but the way we think about leadership now is more in the vein of wholeness and patterning and mutual process.
PC: Certainly we see new paradigm thinking in the literature in terms of the evolution from management to leadership. RC: I wonder too, if there is something that goes beyond leadership? WC: Mainstream organizations are shifting more and more toward new paradigm thinking. By the time they get there they won’t be new paradigms anymore. Maybe that’s true already, but, for example, appreciative inquiry is in the mainstream textbooks. And values-based has become a buzz-word in schools of business. The business school leaders go beyond business itself to valuesbased concepts and vision, which means you have a vision rooted in values; you want to co-create, and that’s actually mainstream now. Richard is right, the new thinking is more valued now than it has been in the past and it’s welcomed even beyond nursing. RC: We started a service excellence project at Chamberlain. We wanted to get out of the mindset of reducing it to the customer. My president was asked to take the lead on this project for our parent organization and she engaged her colleagues in creating a model within our College. The concept that she worked from was the idea of that customer service in academia is really about providing the best conditions possible for student success. It does not mean that students do not have accountability for their own learning, but rather
excellent service means assuring that we do everything that is possible to facilitate students reaching their optimal possibilities. That was the birthing of what we call Chamberlain Care. A part of this initiative is for all of us, no matter what we do in the organization, to remember that the student is the center of the concern of our organization. A mortarboard that is placed in every meeting room of our home office symbolizes their success. This serves to remind us why we exist. I think of it is as an expression of the unitary concept of pan-dimensionality – we bring the student into our meetings without their physical presence. By doing this a kind of energy is created through symbolism and metaphor that says, “We’re here doing this work for our students.” PC: Coming into the Robert Wood Johnson (RWJ) Executive Nurse Leaders experience as a Parse scholar Bill, how would you describe the impact of the leadership experience on your perspective? WC: The thing that jumped out at me was the notion, we were talking about earlier about the Robert Wood Johnson Executive Nurse Leaders experience; Two things I took away from that was leading as who you are and knowing self in order to be a strong leader. For me, that is very much analogous to knowing oneself within the context of one’s theoretical perspective, and I’ve written about that (Cody, 2000). If my theoretical perspective informs my understanding of my own reality then leading as who I am is also leading from that theoretical perspective. The RWJ experience also gave me the chance to appreciate the huge diversity of leadership styles. We have introverts and extroverts (in traditional terms), and when we would practice presentations in our groups some people would turn cartwheels and others would want to stand at the podium and some would sing. Others would be very good at creating diagrams or models. Some would be forcefully persuasive with public speaking and others would be subtly persuasive in soft tones. New paradigm theories lead us to appreciate human individuality and the uniqueness of each human being. When you express yourself as a leader in the way that is best for you, as a person, to express yourself, then that helps to develop all the members of your work group or team or colleagues to be who they are and to fully realize who they are. That, to me, is the essence of leadership. RC: That’s a central core idea, you mention Bill, which I too seek in my experience as a vice president because we employ executive coaches. One of the executive coaches that we use with individuals and our team always starts with the principle: you have to be who you are. This is not about changing centrally who you are, as a matter of fact it’s embracing who you are and paying attention to how authentic and genuine you are in the organization and when you
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Clarke and Fawcett / Scholarly Dialogue feel you can’t be that’s informational energy telling you that something is going on. We are such a thought-driven culture but paying attention to how we feel is also important. That kind of coaching is in line with what you are saying. My executive coach would always start with me reflecting on who I am and what I want; thinking of the match between the job I chose and me as a person. The approach is truly central and goes along with the newer transformational paradigms of leadership. PC: Richard, talk about the principle of the Chamberlain model and the impact on employees and colleagues. RC: The whole of the DeVry Company decided to have yearly summits where they bring in organizational leaders. We had one last year and brought in a guy who teaches leadership from the paradigm of the symphony. As a former conductor, he brought an orchestra into a room of 400 participants and asked everyone to move about, paying attention to the changes in music; particularly when he told a section to do something different or more creative. Then he asked, “What happened here?” He applied it to organizational theories of leadership. The metaphor of the symphony and the relationships among all in creating conditions of change is another expression of the relevance of patterning, wholeness, and mutual process in an organization. All of this is about learning a new consciousness that leads to new unitary competencies. PC: Perhaps we could summarize by talking a bit about the structure of your organizations, As I understand it yours Richard is a private proprietary, and yours Bill, yours is a religious institution. WC: Yes, it’s Roman Catholic and Vincentian. I was actually thinking about that in relation to pan-dimensionality from unitary science, and Parse’s concept of illimitability from humanbecoming theory. The two people who are with us always at a Vincentian institution are St. Vincent DePaul and St. Louise DeMarillac, who was his partner, in the chaste sense. She was a religious woman, and co-founder with Vincent of the Daughters of Charity. They are really with us every day, the whole notion of what they founded, and their statues are on campus. It’s interesting, the difference between St. Ignatius Loyola, at Loyola there’s a statue and he’s sort of imperious and seated alone, and then on the campus of DePaul the statue of St. Vincent is actually hanging out with other bronze statues of kids with their backpacks. I was thinking of that when you are talking about pan-dimensionality. They are definitely with us. They inspire servant leadership, and I have found servant leadership to be consistent with my values base in humanbecoming, in terms of being a servant to the mission and vision of the organization, to my colleagues and co-workers; and the service I provide is to try and lead them. The measure of success, according to the founder of the servant leadership movement, Robert
Greenleaf (Greenleaf, Frick, & Spears, 1996), is the extent of the development of your followers, how well do they develop as human beings and as servants. RC: There is an interesting parallel, I may have a misunderstanding of this, but DeVry Educational Group purchased Deaconess Hospital School of Nursing in St. Louis, which was how Chamberlain originated. Part of the contract was that they use a different name, so they started with a few hundred students. Deaconess has a history; they would be 125 years old today. We see ourselves rooted in Deaconess, which was also a Deaconess Order, and they built a school on the Nightingale model. When we purchased Deaconess, we embraced all of that in a sense; we have some of their statuary that we transported from the old school. There was a lot of discussion about the new name, and Chamberlain has a connotation of “chief steward.” It conveys that we are the stewards of the student’s wellbeing and success. We have grown a lot, we have 13 campuses that are brick and mortar for our pre-licensure BSN program, an RN to BSN program and a variety of master’s tracks (leadership, informatics, and education) and a doctor of nursing practice (clinical and health systems leadership) program that are primarily online. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this column.
Funding The authors received no financial support for the authorship and/or publication of this column.
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